FORM 1023-EZ for HEALING ROOM BREMERTON

Field Data
EIN 83-3884957
Case Number EO-2019070-000334
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name HEALING ROOM BREMERTON
Organization’s Mailing Address 900 MITCHELL AVE APT 106
City PORT ORCHARD
State WA
ZIP 98366-4109
Accounting period End 12
Primary contact name THOMAS PINKHAM
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

THOMAS PINKHAM
ADMINISTRATOR
900 MITCHELL AVE APT 106
PORT ORCHARD WA 98366-4109

Officer/Director/Trustee Two

STEPHANIE ZARIFES
DIRECTOR
9282 TRACYTON BLVD NW
BREMERTON WA 98311-9025

Officer/Director/Trustee Three

LOUISE KLODT
SECRETARY
60 EAST CRIMSON ROAD
BELFAIR WA 98528

Officer/Director/Trustee Four

KEVIN CLANCEY
PASTOR
FIREHOUSE CHURCH - 646 5TH ST
BREMERTON WA 98337-6024

Organization’s website
Organization’s email TOMPINKHAM111@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/16/19
Organization Incorporation State WA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code X20 - Christian
Organization’s purpose Charitable: No
Religious: Yes
Educational: No
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: No
Cruelty Prevention: No
Qualify For Exemption No
Legislation influence No
Compensation of Officer director trustee No
Donation of funds Yes
Conducting Activities Outside of United States No
Financial transactions with officers No
Unrelated Gross Income $1,000 or More No
Gaming Activity No
Disaster relief assistance No
One Third Support Public No
One Third Support Gifts Yes
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name THOMAS PINKHAM
Signature Title ADMINISTRATOR
Signature Date 3/8/19

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